Summary
A 28-year-old woman presented with a first depressive episode, which was initially treated with sertraline titrated to 200 mg daily. After four weeks of antidepressant treatment at the maximum therapeutic dose, her mental state deteriorated, with emergence of auditory hallucinations and suicidal ideation. Treatment with aripiprazole 10 mg daily was initiated and there was a complete resolution of psychotic and depressive symptoms within two weeks. A similar subsequent psychotic depressive episode was treated with sertraline 100 mg and aripiprazole 10 mg daily with good clinical response. A reduction in the dose of aripiprazole to 5 mg daily was accompanied by a rapid reemergence of depressive symptoms. Her mental state improved again following the reinstatement of aripiprazole to 10 mg daily